Private Practice in the United Kingdom

Abstract

surance and private practice have again increased (1). 0*c>edz Growth has been in the face of a National Health Service (NHS) which already provides virtually all of the medical services which private insurance covers. The present National Health Service in the United Kingdom began in 1948. Although there have been several administrative reorganizations, complete coverage of medical, surgical, and hospital care for all UK residents has remained intact. From the beginning medical specialists, if they worked less than fulltime in the NHS, were assured the right to engage in private practice. It was estimated that in 1971-72, part-timers derived a third of their income from private practice (2). However, the levels of supplemental earnings made from private practice by these part-time NHS consultants varied and was a function of specialty (mainly surgery and anesthesiology) and location (London and a few other urban centers). General practitioners (GPs) were also allowed to do private practice without defined limits, but in 1971-72 it made up only 6% of GP income (2). The 1980 contract allowed private practice for full-time as well as part-time specialists (3). This change was in keeping with the goal of the present Conservative government to increase the role of the private sector in health (3). Further evidence of government support for the private health sector is the recent decision that all private insurance payments by employers are no longer taxable as employees' benefits. In this report the nature and growth of private practice and private insurance in the UK will be described, trends analyzed, future implications discussed, and comparisons made with the Canadian health care system.